Additional Details
Payment Updates
- OPPS Rate: CMS建议在2013年之前更新符合适用质量报告要求的医院的OPPS支付率.1%, which is based on a projected hospital market basket update of 3.3% and a 0.2 percentage point reduction for the productivity adjustment. CMS is also finalizing its proposal to maintain the statutory 2.对未达到医院门诊质量报告要求的医院,减少支付0个百分点.
- ASC Rate: In CY 2019, CMS最终确定了将适用于OPPS系统的生产力调整后的医院市场篮子更新应用于ASC支付系统的建议,为期五年(2019年至2023年)。. In this rule, CMS is finalizing its proposal to continue this policy for an additional two years, through CY 2024 and CY 2025. As such, CMS is finalizing a CY 2024 payment update for ASC rates of 2.8%.
- 农村急救医院(REHs)、印第安人保健云顶集团设施(IHS)和部落设施: For tribal and IHS hospitals that convert to an REH, CMS正在最终确定其提案,即按照适用于非REH的IHS和部落设施的相同的全包费率(AIR)方法向提供者支付费用. CMS还将最终确定一项政策,该政策将向IHS和转换为REHs的部落设施提供REH每月的设施付款. CMS指出,这些政策的目的是为转变为REHs的IHS和部落设施带来稳定,并促进这些医院的使用.
- 340B Drugs: CMS is finalizing, without modification, the proposal to continue to pay 340B-eligible hospitals at the statutory default rate, generally ASP plus 6%, for 340B-acquired drugs and biologicals.
- Of note, CMS issued a related proposed rule on July 7, 2023, 讨论2018年至2022年期间向符合340b标准的医院支付340b标准药品的建议补救措施. This remedy would include an estimated $9 billion lump sum payment for roughly 1,600 hospitals, 在未来的15年期间,所有医院的OPPS付款将被削减,这将为其提供资金. See ECG’s summary of that release here.
Behavioral Health Programmatic Changes and Proposals
- Changes to PHP: 公共云顶集团计划是一项密集门诊方案,旨在作为精神病住院的替代方案,根据公共云顶集团计划按日支付费用. CMS正在最终确定其提案,通过增加两个动态支付分类(apc)来扩展PHP现有的费率结构,其中包括每天提供三种云顶集团的天数的费率和每天提供四种或更多云顶集团的天数的费率. CMS指出,该政策将适当提高所有设置下高强度天数的支付率. This payment structure would also apply to the newly proposed IOP outlined below.
- IOP: CMS is finalizing the establishment of the IOP under Medicare. IOP是为患有急性精神疾病或物质使用障碍的个体提供的一种独特的精神病学门诊云顶集团项目.
- CMS正在最终确定医院门诊部可以提供IOP云顶集团的政策, Community Mental Health Centers (CMHCs), Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs).
- CMS正在最终确定将包含在IOP中的云顶集团代码的综合列表,这些代码以前是作为PHP福利的一部分支付的,或者更普遍地是在OPPS下支付的. CMS is also finalizing the establishment of two APCs (one rate for days with three services, 有四项或更多云顶集团的天数为一项),并将使用更广泛的OPPS数据集(包括PHP天数和非PHP天数)以每天的成本为基础支付费率.
- For CY 2024, CMS还最终确定了将IOP覆盖范围扩大到包括阿片类药物治疗计划(otp)的提案。. CMS正在通过otp提供的IOP云顶集团的附加代码建立每周付款调整.
- Changes to CMHC Condition of Participation (CoP): To implement provisions established by the Consolidated Appropriations Act (CAA) of 2023, CMS正在最终确定修改cmhc要求的提案,以在整个cop中包括IOP云顶集团. CMS也在最终确定对人员资格的修改,包括心理健康咨询师(MHC)的修订定义,并增加婚姻和家庭治疗师(MFTs)。. Finally, CMS正在最终确定将MFTs和mhc添加到可以在必要时领导跨学科团队会议的从业人员名单中.
Quality Programs
- CMS正在最终确定医院门诊质量报告(OQR)和门诊外科中心质量报告(ASCQR)计划的几项变更, as follows:
- Finalized Measures for Adoption:
- 风险标准化患者报告的选择性原发性全髋关节和/或全膝关节置换术后的结果测量,以提供对普通手术护理质量的具体见解
- (建议在医院采用(仅限OQR)成人诊断计算机断层扫描(CT)的辐射剂量过高或图像质量不足,以促进患者安全的电子临床质量测量(eCQM)
- Finalized Measures for Modification:
- 卫生保健人员COVID-19疫苗接种覆盖率(HCP)措施与最新的疾病控制和预防中心(CDC)国家卫生保健安全网措施规范保持一致
- 白内障术后90天内患者视功能改善情况测量调查仪器,进一步规范数据采集,减轻设施负担
- 测量平均风险患者正常结肠镜检查的适当随访间隔,以符合最新的临床指南
- Of note, 在公众反馈后,CMS尚未最终确定重新采用医院门诊/ASC设施数量数据的建议.
- CMS is also not finalizing the proposal to remove the Left without Being Seen measure.
- Within the Rural Emergency Hospital Quality Reporting (REHQR) Program, CMS is finalizing its proposal to adopt four initial measures, including three claims-based measures and one chart-abstracted measure as follows:
- Abdomen CT: Use of Contrast Material
- 出院急诊科患者从急诊室到达到急诊室离开的平均时间
- Facility 7‑Day Risk‑Standardized Hospital Visit Rate after Outpatient Colonoscopy
- Risk-Standardized Hospital Visits within Seven Days after Hospital Outpatient Surgery
Other Updates
- To strengthen compliance around use of hospital price transparency data, CMS正在最终确定修改45 CFR 180标准收费显示要求的提案.50 and the proposed enforcement provisions at 45 CFR 180.70 to streamline the transparency of the enforcement process.
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Edited by: Matt Maslin
Published November 2, 2023